Form CFS431-D "Request for Copy of Psychotropic Medication (Or Other) Consent" - Illinois

What Is Form CFS431-D?

This is a legal form that was released by the Illinois Department of Children and Family Services - a government authority operating within Illinois. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2012;
  • The latest edition provided by the Illinois Department of Children and Family Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form CFS431-D by clicking the link below or browse more documents and templates provided by the Illinois Department of Children and Family Services.

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Download Form CFS431-D "Request for Copy of Psychotropic Medication (Or Other) Consent" - Illinois

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CFS 431-D
4/2012
State of Illinois
Department of Children and Family Services
Request for Copy of Psychotropic Medication (or Other*) Consent
All requests for copies of consents must FIRST be made to the child’s caseworker/supervisor.
If the copy is not received in a timely manner AND the consent was a psychotropic medication
consent or a different type of consent that was issued by the DCFS Consent Unit, complete this
request form and fax to the Consent Unit at (312) 814-4128.
Date of request:
Child’s name:
Date of birth:
DCFS I.D. #:
Check appropriate box for type of consent request:
Psychotropic medication
Date medications were approved:
List medications:
Other (only for consents issued by the Consent Unit *)
Date approved:
Procedure/medication:
To be completed by medical or other provider:
Date request made to child’s caseworker/supervisor:
Caseworker name:
Phone number:
Requestor’s Name:
Title:
Phone:
Requestor’s fax number:
To be completed by requesting DCFS / POS caseworker:
Caseworker’s Name:
Phone:
Fax number:
Requests will be processed within 5 – 7 business days of date received.
* The DCFS Consent Unit cannot provide copies of medical consents signed by authorized
agents at the DCFS Regional or Field Office. The caseworker must obtain these documents.
CFS 431-D
4/2012
State of Illinois
Department of Children and Family Services
Request for Copy of Psychotropic Medication (or Other*) Consent
All requests for copies of consents must FIRST be made to the child’s caseworker/supervisor.
If the copy is not received in a timely manner AND the consent was a psychotropic medication
consent or a different type of consent that was issued by the DCFS Consent Unit, complete this
request form and fax to the Consent Unit at (312) 814-4128.
Date of request:
Child’s name:
Date of birth:
DCFS I.D. #:
Check appropriate box for type of consent request:
Psychotropic medication
Date medications were approved:
List medications:
Other (only for consents issued by the Consent Unit *)
Date approved:
Procedure/medication:
To be completed by medical or other provider:
Date request made to child’s caseworker/supervisor:
Caseworker name:
Phone number:
Requestor’s Name:
Title:
Phone:
Requestor’s fax number:
To be completed by requesting DCFS / POS caseworker:
Caseworker’s Name:
Phone:
Fax number:
Requests will be processed within 5 – 7 business days of date received.
* The DCFS Consent Unit cannot provide copies of medical consents signed by authorized
agents at the DCFS Regional or Field Office. The caseworker must obtain these documents.